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Psychiatric morbidities after stroke in Asia: A systematic review

Meliza Angelica J. De Leon ; Alejandro C. Baroque II

Journal of Medicine University of Santo Tomas.2023;7(2):1222-1228. doi:10.35460/2546-1621.2023-0021

Background: Stroke is currently the second leading cause of death worldwide and is one of the leading causes of long-term disability . Mood disorders are prevalent after a stroke and may hinder physical, functional, and cognitive recovery; hence, it is undeniably necessary to recognize them early. Stroke mortality is generally higher in Asia as most of the countries therein are in economic transition . Socioeconomic status is a major contributor to stroke burden as greater odds of disability are found in patients with lower educational status and income. Objectives: The primary objective of this study is to identify the psychiatric morbidities commonly seen after a stroke in Asia. Search Methods: The following databases were utilized for extensive literature search: PubMed (January 2002 to June 2022), Cochrane Library (January 2002 to June 2022), and EBSCO (January 2002 to June 2022). The search made use of keyword combinations, Boolean operators "AND" and "OR," truncations, and field tags last October 2022. Selection Criteria: Articles on the prevalence and cross-sectional studies were included if they involved stroke survivors who developed post-stroke psychiatric morbidities in Asia. Additional inclusion criteria consisted of studies that have to be written in the English language and having free full texts available. Data Collection and Analysis: This systematic review made use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and guidelines. The JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data was used in the assessment for the quality of articles to be included in this systematic review. Results and Conclusion Affective disorders and generalized anxiety disorder were the common psychiatric morbidities identified post-stroke. The Hospital Anxiety and Depression Scale (HADS) may be used to diagnose post-stroke depression and anxiety. Males in their middle to late adulthood with higher National Institutes of Health Stroke Scale (NIHSS) scores and poor stroke outcomes (higher scores in the Modified Rankin Scale) were associated with a higher likelihood of developing the aforementioned psychiatric morbidities.
Depression ; Anxiety ; Mania ; Psychotic Disorders ; Asia

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Adult Glottic Hemangioma: A case report

Lloyd Paolo R. Crizaldo ; Archie Brian C. Ramos

Journal of Medicine University of Santo Tomas.2023;7(2):1229-1234. doi:10.35460/2546-1621.2021-0033

Glottic hemangioma is a benign vascular tumor that is rarely seen in the adult population. We report a rare Filipino case of glottic hemangioma in a 65-year-old female presenting with 2 weeks history of hoarseness and a smooth, pedunculated, bluish mass at the anterior one-third of the right vocal cord in flexible laryngoscopy. Direct suspension laryngoscopy showed a pedunculated mass that was paler-looking, similar to the color of the surrounding mucosa, exhibiting the Phonation sign of Menzel. The patient underwent microlaryngeal excision and histopathology showed findings consistent with cavernous hemangioma.
Vocal Cords ; Hemangioma ; Adult

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A review of the clinical significance of lumbar puncture in the diagnostic approach of Aneurysmal Subarachnoid Hemorrhage (SAH): A case report of CT-Negative and Lumbar Puncture–Positive SAH

Maria Vashti Zerlinda Lesmana ; Edrik Wiyogo ; Frandy Susatia ; Candra Wiguna ; Harsan Harsan

Journal of Medicine University of Santo Tomas.2023;7(2):1235-1243. doi:10.35460/2546-1621.2023-0074

Headaches are a common presentation in the emergency department (ED). Even though not all are potentially serious, some such as subarachnoid hemorrhage (SAH) can be more dangerous than others. SAH is a medical emergency with an almost 50% mortality rate. It is crucial not to miss the diagnosis of SAH, as a missed or delayed diagnosis can be severely detrimental. It classically presents as thunderclap headache, a severe, sudden-onset headache. There are various approaches in diagnosing or excluding SAH, which is classically done by performing a computed tomography (CT) scan followed by a lumbar puncture (LP). But with the improved sensitivity of more modern diagnostic tools, more physicians are in support of changing this classical teaching. The aim of this case report is to review the advantages and disadvantages of LP in diagnosing SAH, along with other diagnostic tools commonly used.
Subarachnoid Hemorrhage ; Spinal Puncture ; Cerebrospinal Fluid

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Developments in post-stroke spasticity care with early use of Botulinum Toxin A: A review

Maria Leila M. Doquenia

Journal of Medicine University of Santo Tomas.2023;7(2):1244-1251. doi:10.35460/2546-1621.2023-0070

Spasticity is one of the most common and disabling complications of stroke. Most of these patients notably experience both muscle-based and non-muscle-based pain. This negatively affects their quality of life as well as aggravates caregiver burden. Post-stroke spasticity (PSS) may furthermore lead to several complications related to limited mobility, both motor (eg, contractures) and non-motor (cognitive decline, depression) if left untreated. It is thus crucial to address this with safe and effective means such as botulinum toxin therapy as early as possible. We aim to demonstrate the utility of botulinum toxin (BoNT) in PSS treatment and how early intervention may be preferable to late spasticity control for patients. Literature search and evaluation were done using the traditional evidence hierarchy. Early intervention with botulinum toxin A (BoNTA) demonstrated a more marked reduction in both spasticity and spasticity-related pain with longer required intervals to reinjection.
Botulinum Toxins ; Pain

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Current insights into Covid-19 vaccination

Tommy C. Sim

Journal of Medicine University of Santo Tomas.2023;7(2):1252-1258. doi:10.35460/2546-1621.2023-0077

Almost a year after the worldwide appearance of the coronavirus (SARS-CoV-2), several novel vaccines of diverse platforms have been successfully developed and administered. Two mRNA vaccines represented a new type of vaccine that comprised of synthetic mRNA molecules containing the code sequence necessary to build the SARS-CoV-2 spike protein. These mRNA vaccines almost single handedly carried the brunt of the US COVID-19 immunization strategy during the past three years. The known and potential benefits of COVID-19 vaccination outweigh the risks and adverse complications. The ongoing COVID-19 pandemic has stimulated unprecedented research on aspects of the vaccines’ ability to reduce the risk of severe infection and death. Likewise, basic immunological studies are pivotal to unraveling the potential and long-term effects of the vaccines as well as to be able to make adjustments to new vaccine development. As the circulating virus strain continues to evolve, updated vaccines will be critical to protecting the population, particularly the elderly and immune compromised.
COVID-19 ; Vaccination ; Post-Acute COVID-19 Syndrome ; Myocarditis

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Effectiveness of platelet-rich plasma as an adjunct to core decompression to treatment outcomes and femoral head preservation in avascular necrosis of the hip: A meta-analysis of randomized controlled trials

Carlo F. Fernandez ; Byron S. Angeles ; Carmelo L. Braganza

Journal of Medicine University of Santo Tomas.2023;7(2):1259-1270. doi:10.35460/2546-1621.2023-0054

Background: Avascular necrosis (AVN) of the femoral head results from intraosseous pathology causing functional impairment. Early diagnosis allows conservative treatment like core decompression, delaying total hip arthroplasty. Objective: This meta-analysis aims to summarize platelet-rich plasma's (PRP) impact as an adjunct to core decompression (CD) on treatment outcomes and femoral head preservation in hip AVN. Methods: The study conducted a comprehensive literature search using PubMed, Cochrane Library, Science Direct, Google Scholar and Med Line, including randomized controlled trials (RCTs) and previous meta-analyses from various databases. Using a random effects model, it compared PRP+CD with bone grafting to CD with bone grafting alone in AVN patients, evaluating function, pain scores, disease progression and the need for hip surgery. Results: The meta-analysis examined 1041 records and included three studies. The primary outcomes were function and pain scores using Harris Hip Scoring (HHS) and Visual Analog Scale (VAS). Postoperative HHS scores at final follow-up favored the PRP+CD group significantly over CD alone. Postoperative VAS scores showed a trend towards higher scores in the CD alone group. The PRP+CD group demonstrated higher survival from disease progression compared to CD alone. Overall, the study suggests that PRP+CD led to better functional outcomes and disease progression outcomes than CD alone in AVN of the hip. Conclusion The PRP+CD treatment group showed significant benefits in AVN patients compared to CD alone, including higher HHS scores, improved disease progression survival and reduced need for hip surgery. Although PRP+CD resulted in decreased VAS scores, the difference was not statistically significant.
Osteonecrosis ; Femur Head ; Platelet-Rich Plasma ; Randomized Controlled Trial

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Epidemiology of dermatologic conditions among elderly patients at the Ambulatory Care Service of a Tertiary Hospital in Metro Manila from 2014 to 2018: A five-year review

Irene B. Cua ; Eleanor Lo-Letran

Journal of Medicine University of Santo Tomas.2023;7(2):1271-1287. doi:10.35460/2546-1621.2021-0002

Introduction: Ageing is a progressive degenerative process that leads to decline in the physiological function and reserve capacity of the whole body system, including the skin. As the Filipino geriatric population escalates, the incidence of skin diseases becomes more widely acknowledged. Presently, there are only a few studies that have been reported locally describing the nature of geriatric dermatoses. Objectives: To describe the epidemiology of dermatologic conditions among Filipino elderly patients that prompted a consult at the ambulatory care service of a tertiary hospital between the years 2014 and 2018. Methodology: All Filipino elderly patients with dermatological conditions seen at the dermatology ambulatory care service from 2014 to 2018 was studied through a single-center, retrospective, descriptive study. Results: Elderly patients comprised 16.76% of the total patients who sought dermatological consultation at the ambulatory care service of the hospital. Majority of the patients were females. Xerosis/xerotic eczema (10.02%) was the most frequently encountered skin disease. The top 10 diseases were irritant contact dermatitis (7.00%), lichen simplex chronicus (6.67%), psoriasis (5.56%), seborrheic dermatitis (5.24%), allergic contact dermatitis (4.37%), tinea pedis (3.51%), herpes zoster (3.49%), seborrheic keratosis (3.23%), and milia (2.54%). Based on the nature of disease, inflammatory condition was the most commonly seen. Conclusion Dermatological disorders are ubiquitous in older people with a significant impact on the quality of life. Inflammatory dermatoses comprise a wide array of skin diseases as evidenced in this study, which account for most of the cutaneous problems in the elderly. Similar to other epidemiological studies, xerosis/xerotic eczema still comprises majority of the cases prompting elderly patients to seek a dermatological consultation.
Aged ; Epidemiology

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Clinical and patient reported outcomes of Vitamin E diffused highly cross-linked polyethylene liner versus moderately cross linked polyethylene liner in total hip arthroplasty: A meta-analysis

Diovince S. Tan ; Byron S. Angeles

Journal of Medicine University of Santo Tomas.2023;7(2):1288-1301. doi:10.35460/2546-1621.2023-0051

Introduction: In the modern era of Medicine, total hip arthroplasty (THA) is found to last longer than ever before due to the fact that there has been improved bearing surfaces and materials available. Despite these modern approaches, failure caused by polyethylene wear, aseptic loosening, instability and mispositioning and even infection could affect THA survival. In the course of addressing anti-wear characteristics of the conventional polyethylene surface various approaches have been made. To date, there are very limited studies done in which polyethylene liner is better. General Objective: To compare the effects of vitamin E diffused highly cross-linked polyethylene liner versus moderately cross-linked polyethylene liner in THA. Methodology: Meta-analysis research design was used in this study. The primary investigators conducted a comprehensive literature search from Medline, Cochrane Library, PubMed, Elsevier, Google Scholar, Embase and ClinicalTrial.gov as electronic database. All randomized controlled trials comparing the effects of vitamin E diffused highly cross-linked polyethylene liner versus moderately cross-linked polyethylene liner in THA were included in the review. Conclusions The investigation disclosed no statistical significance between moderately cross-linked polyethylene liner and vitamin E diffused highly cross-linked polyethylene liner in terms of migration, head penetration and wear on mediolateral, longitudinal and anteroposterior axes after 2 and 5 years of undergoing THA. Moreover, the data pertaining to patient reported outcomes and clinical outcomes measure also indicated no statistical significance between moderately cross-linked polyethylene liner and vitamin E diffused highly cross-linked polyethylene liner. This indicates that vitamin E diffused highly cross-linked polyethylene liner is comparable with the conventional moderately cross-linked polyethylene liner. Vitamin E-infused highly cross-linked polyethylene ( VEPE) showed an almost similar stability with regard to the wear rates and the component showed similar stability with that of moderately cross-linked polyethylene liner.
Arthroplasty, Replacement, Hip

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Indications and outcomes of Tracheostomy: A descriptive study using the outcome-based evaluation forms of Otorhinolaryngology - Head and Neck Surgery Department in a Tertiary Hospital (2016-2020)

Divina V. Ampoloquio ; Archie Brian C. Ramos

Journal of Medicine University of Santo Tomas.2023;7(2):1302-1309. doi:10.35460/2546-1621.2023-0033

Introduction: Tracheostomy is a surgical procedure that creates a neck opening directly into the trachea, typically performed to establish an alternative airway for individuals who experience difficulty breathing as a result of certain medical conditions. Tracheostomy can be temporary or permanent, and it plays a crucial role in the management of both acute and chronic respiratory issues and can significantly improve the quality of life for those who require it. Objective: This study aims to investigate the incidence, common indications and outcomes of tracheostomy in the Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) department of a tertiary hospital in Manila, Philippines. Methodology: This is a retrospective descriptive study including all admissions and in-patient referrals to the clinical division of the Department of Otorhinolaryngology-Head and Neck Surgery who underwent tracheostomy from January 2016 to December 2020. Data were retrieved by review of medical records and Outcome Based Evaluation (OBE) form of all patients who underwent tracheostomy during the study period. Results: Our study involved 74 patients with a male-to-female ratio of 22:15. The patients' ages ranged from 5 to 89 years. Prolonged intubation was the main reason for tracheostomy, followed by upper airway obstruction due to supraglottic mass for males and vocal cord paralysis for females. Only three patients who had tracheostomy experienced complications and were managed accordingly. Conclusion Tracheostomy is one of the most valuable and reliable surgical procedures for managing airway obstructions. Proper patient and caregiver education as well as constant follow-up are crucial to prevent complications.
Tracheostomy

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The role of pigmented rice in reducing cardiovascular disease risk: A mini-review of animal and human studies

Diane S. Mendoza-Sarmiento ; Alison M. Hill

Journal of Medicine University of Santo Tomas.2023;7(2):1310-1316. doi:10.35460/2546-1621.2022-0089

Higher dietary intake of polyphenols is associated with a reduced risk of cardiovascular disease (CVD) events and mortality. However, these phytochemicals are predominantly present in fruits and vegetables, which are inadequately consumed by some populations, including Filipinos. This narrative mini-review explores the potential role of polyphenol-containing pigmented rice consumption in modulating risk through a range of mechanisms identified in animal studies. Further, human studies have demonstrated promising but inconsistent effects on risk factors associated with the development of CVD, such as dyslipidemia, hyperglycemia, overweight and obesity. Therefore, this review identifies the need for more clinical trials to examine the effect of pigmented rice on CVD risk factors.
Cholesterol ; Glucose ; Polyphenols

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